| NPI | 1083271209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26542) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002056) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2026-05-11 |